| NPI | 1407907801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904003126) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC lc30202744) |
| 1041C0700X Social Worker, Clinical (Licence: MD 08693) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-07-08 |